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The Hip Chronicles, Part II: I wanna be sedated

In my series, the RA Diaries, I’ve tried to write about the weird, the painful and even the comical parts of having a chronic illness. Very recently, I had what for many RA patients is a rite of passage: my first joint replacement. My new right hip, with its festive combination of titanium, cobalt and plastic polymer, is worth five times more than my car. And it will surely be a great source of amusement to TSA scanners worldwide, because on x-rays it looks like I’m packing some major heat.

Now, kind reader, let me tell you exactly how I went about getting my new hip. But be warned. It’s gonna get gross. And graphic. And, maybe once in a while, somewhat amusing. I hope you get something out of it. I’m certainly hoping I will.

As I lay on my back on the narrow hospital cot, clad only in a backless cotton robe and paper socks, two thoughts kept chasing each other in my mind like squirrels in a tree: “Please let this be over soon, because all I want is to see my husband before they take me in to surgery,” and “Who the hell would have thought I was so difficult to knock out?”

A nurse sat at a computer to the left of my head. As she typed, her elbow made the curtain surrounding the pre-op cubicle billow. She was asking question after question, mostly about address and date of birth, but I was having a really hard time focusing.
The reasons for my distraction were on either side of me; two anesthesiology residents were tugging and squeezing and slapping at my hands and arms, trying to find a vein so they could put in an IV. They had already failed twice; the young resident on my right side had blown my best vein with one inexpert jab, tried to get the nurse at the computer to find another vein and have a try (she refused), then went to get reinforcements.

I had spoken to this same young resident the day before, and he had explained the anesthesia procedure. First, he said, they would place an intravenous device in my hand, which would feed me something to make me groggy. Then, they would take me into the OR, where they place another IV in my back, also known as an epidural. The epidural immobilizes your legs for up to 10 hours, and then painkillers get swapped out, so you don’t need to rely as much on a morphine drip in your hand IV. After that, it’s a couple of hits of gas, probably propyphol — and goodnight, A.K!

While he acknowledged that the second epidural had risks of infection and even paralysis, he reassured me that it was preferable to general anesthesia, which would include oxygen tubes down my airway and a lot more monitoring and complications.

Neither sounded good to me, but I opted for the epidural, especially after his attending came to visit me shortly after I had changed into my robe. She made it clear that was not just my best option; it was my only option.

But as I lay there, feeling them slapping at my limbs (by the third failed attempt, they zeroed in on my left leg; the right was safe, because it was being operated on), I wondered if we were going to get to the operating room at all. I could hear my surgical team muttering about it behind the curtain, or maybe it was my neighbor’s surgical team — her pre-op prep seemed to be taking forever too.

There were only so many veins I was willing to sacrifice for the cause, and so I decided it was not too late to say “Screw it, I’m going home! Keep your fucking fake hip, you incompetent jerks! I’ll drink the chronic pain away!” (I sometimes get unrefined under stress).

But before I could vent my spleen, the resident on the left finally hit the jackpot, placing the needle in the vein on the inside of my left wrist. Normally, you don’t place IVs there, since that vein is small and wrapped in nerves and hurts like hell to poke.

(Which also makes me wonder why it is the vein of choice for suicidal people. I still remember my friend Debi in high school showing me the scars from her failed attempt freshman year. “It really hurt,” she said. “No shit, Debi.”)

But he numbed me up and went for it, commenting as he did so that he was using the smallest IV possible. Why they hadn’t thought of using a smaller IV in the first place is beyond me, but at that point, I didn’t care.

“Can I please see my husband now?” I felt like I’d been begging to see him forever.

They ushered him in at last, and my relief at seeing someone not in scrubs wielding a needle made me start crying. They let him stay with me for just a few minutes, and we hugged and we kissed and said goodbye until later (I must confess a big part of me wondered if there would be a “later,” but then again, I wasn’t exactly in a great place at the time.)

Then, it was time for the epidural. Why I thought that would be less painful is probably a mixture of denial and misplaced faith in the attending doctor.

They wheeled me into a large room. I know it was the operating room, but there were none of the accoutrements one gets used to seeing on TV. Where were the machines that go “ping”? I insist on machines that go “ping!” And what about the robot arms? Aren’t hips replaced by robot arms these days?
Or maybe I was just too messed up by the sedative dripping slowly into my suicide vein, and too near-sighted (my glasses stayed with my husband) to notice them.

I was instructed to sit on the edge of a long table with my back curled. A resident sat in front of me to support me (and let’s be honest — prevent me from escaping).

Then the slapping and prodding began again.

Anyone who has had a nerve stuck with a needle will tell you it’s very different from having your veins stuck. A stuck nerve feels like it’s on fire, like a tiny bolt of lightning shooting down (never up, always down) its course, however long that may be.

I got stuck once. Then again. Then again. The third time was the worst, since the lightning bolt sparked all the way down my leg. I could hear the attending muttering angrily behind me as she kept striking out. The words “scoliosis” and “arthritis” were thrown around.

After half a dozen attempts, she gave up.

No epidural for this one! It would have to be general anesthesia after all. They sat me up and put a mask on my face. I took several deep breaths, and just before everything went dark, I made myself promise:

“If you make it through this, you will strive to be a kinder, better person. You will also remember every detail, and put it on your blog.”

All text copyrighted by A.K. Whitney, and cannot be used without permission.

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4 comments

Wow, reading this made me angry. It seems like so much unnecessary torture. Since joint replacements seem to be fairly common for patients with RA, one would hope that staff at an orthopedic hospital would be better informed about medical issues like difficulty taking blood, challenges of administering epidurals on an RA patient, etc. I’m sorry that you had to go through this.

This sounds like it was quite challenging for you. I hope the rest of the procedure went more smoothly.

Yesterday, I had an outpatient procedure and, while I was in the recovery room, a saleswoman was demonstrating a new device. So I asked for a demo.

It somehow can tell where your blood in your veins is. It puts green lines over them. The closer the vein is to the surface, the clearer the line. I hope your medical establishment can afford one of these before your next procedure.